DE102005040173B4 - Method for positioning the focus of a therapy source of a lithotripter to a concretion and mobile device for carrying out the method - Google Patents

Abstract

Method for positioning the focus (19) of a therapy source (18) of a lithotripter to a calculus in an examination object (13) by means of a multi-adjustable C-arm (6) of a mobile X-ray diagnostic device, on the inside of which the therapy source (18) with an integrated imaging Ultrasound diagnostic device is arranged, the focus (19) of the therapy source (18) lying outside the beam cone (12) of the X-ray diagnostic device and by means of an X-ray diagnostic device, which has an X-ray source (8) at one end of the C-arm (6) and an X-ray source at the other end X-ray receiver (7) and has position sensors on all preferably motorized adjustment axes of the C-arm (6), the signals of which are processed in an image processing and control computer of the X-ray diagnostic device, the method comprising the following method steps: (1) Fixation of the examination object (13) with the concrement he storage device, (2) recording of at least two different 2D X-ray projection images of the calculus, each projection geometry being defined by a set of measured values from the position transmitter, (3) marking of a target point (17) for the focus (19) inside ...

Description

The invention relates to a method for positioning the focus of a therapy source of a lithotripter to a calculus and a mobile device for carrying out the method.

Methods for lithotripsy treatment with mobile devices are known from the patent literature.

From the German Utility Model DE 299 23 561 U1 a therapy device with a therapy head and a locating device is known, in which the focus of the therapy head and a virtual therapy point of the locating device are made to coincide in a calibration process and in which the position of the focus can be detected with position sensors, wherein the therapy location in the patient by displacement of the Patients in the virtual therapy point is brought.

From the German patent application DE 100 32 982 A1 a method and a device for positioning the therapy focus of a therapy unit to the target cross of an X-ray C-arm is known, wherein the position of the therapy focus is detected and monitored by means of a location of the therapy unit detecting position detection system relative to the target cross of the X-ray C-arm.

From the German patent application DE 102 36 176 A1 is a mobile Lithotripsieeinrichtung with a multi-adjustable patient bed, a mobile X-ray diagnostic device with a C-arm and an isocentrically arranged therapy source known. A concretion to be treated is positioned by means of the patient bed on the focal point of the therapy source. The therapy source is pivotally mounted on the C-arm profile and can be swung out of the clear opening of the C-arm.

The DE 197 46 956 C2 has a carriage on a multi-adjustable X-ray diagnostic device with a C-arm, which carries on the C-arm center side facing the C-arm a circular arc-shaped guide for a therapy source at which it is slidably mounted along the circumference. The focal point of the therapy source remains stationary relative to the C-arm and lies on the central beam of the X-ray diagnostic device.

From the EP 0 739 609 B1 a lithotripter is known in which an x-ray device is pivotally mounted about an approximately vertical axis. When pivoting about this axis, the X-ray device is moved from a first position to a parking position in which singular X-ray examinations can be performed. Here, the central beam of the X-ray device is swung out of the focus area of a therapy device and an examination of the patient can be carried out without any obstruction by the X-ray device. The therapy device is held with the X-ray device for positioning on a common XYZ translational movement kinematics, which should always enable a good isocentric alignment of the therapy device and the X-ray device. The movement kinematics can be realized in a relatively complicated manner, in particular in combination with the pivoting of the x-ray device.

From the DE 298 24 080 U1 An isocentric system is known in which an x-ray device and a therapy device are movable about an isocenter, wherein the x-ray device and the therapy device are aligned in each spatial position on the isocenter. In the isocenter, a horizontal axis about which both the X-ray device and the therapeutic device are movable and the central beam of the X-ray device intersect. Furthermore, the focus of the therapy device is located in the isocenter. Around the approximately horizontal axis, the X-ray device and the therapy device are movable independently of each other. Independently of a movement about the approximately horizontal axis, the therapy device can perform a further orbital movement about the isocenter. In this way, a Lithotripsiebehandlung made from a variety of spatial positions. Regardless, with the help of the X-ray device recordings from different directions can be realized.

The object of the invention is to provide a method for positioning the focus of a therapy source of a lithotripter and a lithotripter to be produced inexpensively, which can be converted into a fully fledged mobile X-ray diagnostic device with a few simple steps.

This object is achieved with the objects of the independent claims. Advantageous embodiments of the invention are specified in the subclaims. On a mobile X-ray diagnostic device with a C-arm, a therapy source is preferably adjustably mounted on a holder on the side of the C-arm profile facing the C-arm center, and the holder is detachably arranged on the C-arm profile. The focus of the therapy source is at each adjustment position in the space between the inside of the C-arm profile and the Zentraistrahl the X-ray diagnostic device and always outside the central beam. The method according to the invention for carrying out a lithotripsy treatment assumes the location of a calculus with the help of at least two X-ray projections with different projection geometry. The rolls of the mobile X-ray diagnostic device are preferably locked during locating and during the treatment. A treating physician preferably marks the concretion or a specific part of the concretion (target point) in the 2D projection images displayed on a monitor and in an image processing computer of the X-ray diagnostic facility the coordinates of the target point are then determined in relation to the locked car and thus with respect to the car Floor fixed coordinate system determined. To characterize the projection geometries, the X-ray diagnostic device is equipped in its adjustment axes (swivel axes, linear guides, C-arm guide, lifting column) with position sensors, which enable a reproducible adjustment of the C-arm in the room. The therapy source arranged on the inside of the C-arm profile is positioned on the location of the concretion after determining the position of the concretion with its focus taking advantage of the kinematics of the C-arm. The positioning can optionally be done automatically by motors in the adjustment axes or manually by an operator. After the therapy source has been positioned, the shockwave therapy can be started. The therapy source is equipped with an ultrasound imaging system that allows control of the position of the calculus during lithotripsy treatment. Preferably, the imaging Ultraschallmeßsystem is structurally associated with the source of therapy.

The device according to the invention will be explained in more detail with reference to the figures.

In 1 is a lithotripter according to the invention with a therapy source 18 and a mobile X-ray diagnostic device in a position, the X-ray location of a concretion at the location of the target point 17 serves. The mobile X-ray diagnostic equipment, one on rollers 14 . 15 stored and along the floor 16 movable equipment cart 1 is first positioned so that the in the examination object 13 located target point 17 within the beam cone 12 lies. the one through the focal spot 9 the X-ray source 8th and the entrance window 11 of the X-ray receiver 7 is fixed. In positioning the X-ray diagnostic device, it is advantageous for the subsequent calculation of the position of the target point when the target point is in the vicinity of the central beam 10 to come to rest; However, it is by no means necessary to position the X-ray diagnostic device such that the target point 17 on the central ray 10 to come to rest. The X-ray source 8th and the X-ray receiver 7 are at the ends of a C-arm 6 which is along its circumference in a C-arm bracket 5 around the center 60 slidably mounted, arranged. The C-bow holder 5 is on the equipment cart 1 arranged repeatedly adjustable. The C-bow holder 5 is with a pivot bearing 4 on a horizontal guide 3 pivotally mounted about a horizontal axis. The horizontal guide 3 is on a pillar 2 height adjustable and around the vertical axis of the column 2 rotatably mounted. All adjusting devices (hereinafter referred to as "adjustment axes") of the C-arm 6 are equipped with position measuring sensors whose measured values are fed to a central motion control of the X-ray diagnostic device. It is envisaged to execute all adjusting axles either individually or in their entirety by braking lockable. In particular, it is provided the roles 14 . 15 equipped with a parking brake. In one embodiment of the invention, the adjustment axes are adjustable by motor, wherein the arranged in the adjustment axes motors are controlled by a central motion control of the X-ray diagnostic device. The motor positioning is preferably under the visual control and a permanent manual confirmation by an operator. In the event of an impending collision of sections of the C-arm 6 or the therapy source 18 with the examination object 13 or the patient couch would be stopped immediately by an action of the operator's automatic positioning. The positioning can be continued after eliminating the risk of collision. In the event that the adjustment axes only have position measuring sensors and no adjusting motors, the current positions of the adjustment axes and the target positions are made visible on a monitor, not shown, or other suitable display device for the operator. The setting of the adjustment axes is then made according to the specifications of the controller by an operator.

The therapy source 18 is by means of a releasable holder 20 at the C-bow 6 arranged. In a first embodiment of the lithotripter, the source of therapy is 18 in a holder 20 rigid and detachable arranged on the inside of the C-arm profile. In a second embodiment of the lithotripter, the source of therapy is 18 in the holder 20 optionally held repeatedly adjustable, with always the focus of the therapy source outside the central ray of the X-ray diagnostic device and preferably outside of itself between the X-ray source 8th and the X-ray receiver 7 extending beam cone 12 lies. In this case, the holder has position sensors in the adjustment axes of the holder 20 whose signals are a central motion control of the X-ray diagnostic device to be supplied. For example, the source of therapy 18 on the bracket 20 stored so adjustable that the focus 19 a component of motion perpendicular to that through the center 60 of the C-arm 6 walking C-arc level experiences. It is provided in the second embodiment of the lithotripter to design the adjusting device such that the focal point always comes to lie outside the central beam.

The therapy source has a variable in its volume and its shape coupling body 23 on that in 1 indicated by dashed lines. In the position of the X-ray diagnostic device, which is used to locate a concretion, is the coupling body 23 generally withdrawn to its minimum volume. An ultrasound imaging device preferably used to control the position of the concrement with respect to the therapy source is disclosed in US Pat 1 not shown. It is preferably structurally combined with or integrated into the therapy source.

To determine the location of the destination point 17 With respect to the coordinate system of the X-ray diagnostic device, the recording of at least two X-ray projections with different projection geometry is required. Between the recording of the projection data records, for example, the C-arm along its circumference (orbital motion) or about the horizontal pivot axis in the pivot bearing 4 adjusted.

In 2 the lithotripter according to the invention is shown in the position in which a therapy of the calculus in the target point 17 is possible. The C-arm is adjusted so that the focus 19 the source of therapy 18 on the destination point 17 , the place of concretion, comes to rest. The coupling body 23 is in the example of 2 such that it is the surface of the examination object 13 in the area of the sound wave cone 63 encloses.

The positioning of the therapy source can be done fully automatically if all adjustment axes are motorized. Preferably, however, by an operator, usually by the attending physician, the source of therapy manually coarsely positioned and there is a subsequent fine positioning motor by the motion control. However, the fine positioning can also be performed manually according to the specifications of the motion control for the setpoint positions and the representation of the values of the actual positions of the adjustment axes.

To a destination point 17 which is not in the C-bow plane of the arrangement of 1 to be able to start, it is provided in the first embodiment of the lithotripter, the horizontal guide 3 around the vertical axis of rotation of the column 2 or / and the C-arm bracket 5 in the pivot bearing 4 to pivot about a horizontal axis. In the second embodiment of the lithotripter the source of therapy is 18 in the holder 20 adjustable. It is provided to equip the adjustment axes of the therapy source with position sensors and to process the measured values of the position sensors in the motion control of the X-ray diagnostic device. Optionally, the adjustment of the bracket 20 the source of therapy 18 motorized.

In 3a and 3b are two embodiments of the adjustable bracket 20 shown schematically. In 3a is the source of therapy 18 around a pivot axis 21 pivotally mounted, wherein the pivot axis 21 approximately parallel to the axis of the central steel 10 from the 1 and 2 runs. The bearing for the pivot axis 21 is on the profile of the C-arm 6 detachably arranged. By pivoting the therapy source 18 around the pivot axis 21 he is focus 19 . 19 ' between the C-bow plane 61 parallel target levels 62 . 62 ' pivotable.

In the example of 3b is the source of therapy 18 . 18 ' on a linear guide 22 perpendicular to the C-bow plane 61 linearly displaceable. The range of motion of the focus 19 . 19 ' lies between the target levels 62 . 62 ' ,

The adjustment of the therapy source is not on the in 3a and 3b limited simple adjustment shown. It is intended to carry out the bracket as a multi-joint fitting with either four or seven arms or as a ball joint.

The X-ray diagnostic device with the therapy source 18 out 1 can be used in a number of examination situations as a full-fledged X-ray diagnostic device, namely, when the closed by the treatment source depth of the C-arm opening depth 6 is sufficient for an examination situation. It is envisaged, the C-arm with flanged therapy source by suitable balancing masses in the region of the housing of the X-ray receiver 7 balance. In cases where a free C-arm opening is required to position the C-arm, it is intended to remove the source of therapy from the profile of the C-arm. For this purpose, the holder is provided 20 provided with a shoe which is held releasably and reproducibly positionable in a fixedly arranged on the C-arm recording by means of a quick-release device without the use of tools. The after the removal of the therapy source 18 changed mass distribution of the C-arm 6 was cause the C-bow 6 is no longer balanced. In order to restore the balance, it is provided to arrange on the recording for the therapy source a substantially smaller in volume compensation body made of a material of high atomic number, the mass of the compensating body is equal to the mass of the therapy source with not pumped coupling body. For this purpose, the leveling compound has an identical shoe in form as the therapy source. By means of a detachably arranged compensating body, the lithotripter after removal of the therapy source can be used as a complete X-ray diagnostic device. By the possibility of the C-arm 6 together with the releasably arranged balancing mass to be provided with a sterile cover, the X-ray diagnostic device can also be used in the field of surgery.

List of pictures:

1 : X-ray diagnostic device in locating orientation

2 : X-ray diagnostic device in therapy orientation

3a : Therapy source with swiveling holder

3b : Therapy source with linear guidance

LIST OF REFERENCE NUMBERS

1

trolley

2

pillar

3

horizontal guide

4

pivot bearing

5

C-arm bracket

6

C-arm

7

X-ray receiver

8th

X-ray source

9

focal spot

10

central beam

11

entrance window

12

ray cone

13

object of investigation

14

role

15

role

16

floor

17

Endpoint

18, 18 '

therapy source

19, 19 '

Focus of the therapy source

20

bracket

21

swivel axis

22

linear guide

23

coupling body

60

Center of the C-arm

61

C-arm level

62, 62 '

target level

63, 63 '

Sound wave cone

Claims (9)

Method for positioning the focus ( 19 ) a therapy source ( 18 ) of a lithotripter to a calculus in an examination subject ( 13 ) by means of a multi-adjustable C-arm ( 6 ) of a mobile X-ray diagnostic device, on the inside of which the therapy source ( 18 ) is arranged with an integrated diagnostic ultrasound diagnostic device, wherein the focus ( 19 ) of the therapy source ( 18 ) outside the beam cone ( 12 ) of the X-ray diagnostic device and by means of an X-ray diagnostic device at one end of the C-arm ( 6 ) an X-ray source ( 8th ) and at the other end an X-ray receiver ( 7 ) and on all preferably motorized adjustment axes of the C-arm ( 6 ) Position transmitter whose signals are processed in an image processing and control computer of the X-ray diagnostic device, the method comprising the following method steps: (1) Fixation of the examination object ( 13 (2) receiving at least two different 2D X-ray projection images of the calculus, each projection geometry being defined by a set of readings from the position sensors, (3) marking a target point (3) 17 ) for the focus ( 19 ) inside the concretion by a treating physician, wherein the marking is preferably carried out by means of an electronic pointer in the 2D projection images, (4) calculation of the coordinates of the target point ( 17 ) in the image processing and control computer of the X-ray diagnostic device with respect to a spatially fixed coordinate system, (5) positioning of the focus (FIG. 19 ) of the therapy source ( 18 ) to the destination point ( 17 ) using the kinematics of the C-arm ( 6 ), whereby the treating physician selects from his point of view the best possible orientation of the axis of the therapy source for the treatment ( 18 ) and the image processing and control computer determines the adjustment paths of the C-arm ( 6 ) calculates the specifications of the C-arm ( 6 ) is manually or motorized adjusted such that the focus ( 19 ) of the therapy source ( 18 ) in the destination point ( 17 ) comes to rest. (6) monitoring the position of the calculus during lithotripsy treatment by means of the therapy source ( 18 ) integrated diagnostic ultrasound diagnostic device, (7) positioning of the C-arm ( 6 ) after completion of Lithotripsiebehandlung in an examination position of the method step 2 and Production of a control recording to document the success of the treatment. A method according to claim 1, characterized in that the image processing and control computer by evaluation of the 2D projection data using a 3D model in step 5, an orientation of the therapy source ( 18 ), which minimizes impairment of organs in the vicinity of the calculus, and that the attending physician determines the calculated orientation of the therapy source ( 18 ) may change according to his wishes. Method according to one of Claims 1 to 2, characterized in that the method steps 2 to 6 are repeated if it has been determined by means of the ultrasound imaging device in method step 6 that the target point ( 17 ) is outside the concretion or part of the calculus. Device designed to carry out the method according to one of Claims 1 to 3, comprising an X-ray diagnostic device on a trolley ( 1 ), one relating to the equipment cart ( 1 ) multi-adjustable and equipped in all adjustment axes with position sensors C-arm ( 6 ) carrying at one end an X-ray source ( 8th ), opposite an X-ray receiver ( 7 ) and on its inside a therapy source ( 18 ) with an integrated diagnostic ultrasound diagnostic device, and with an image processing and control computer, wherein the therapy source ( 18 ) on the C-arm ( 6 ) is held so releasably that the focus ( 19 ) of the therapy source ( 18 ) outside of the focal spot ( 9 ) of the X-ray source ( 8th ) and the input window ( 11 ) of the X-ray receiver ( 7 ) spanned beam cone ( 12 ) that the coordinates of the focus ( 19 ) are stored in a C-arm-fixed coordinate system in the image processing and control computer of the X-ray diagnostic device and that the adjustment axes of the C-arm ( 6 ) are lockable and associated with the following movements: • linear movement along a vertical axis of a column ( 2 ) • Rotational movement about a vertical axis • Linear movement along a horizontal axis of a horizontal guide ( 3 ) • Rotational movement about a horizontal axis in a pivot bearing ( 4 ) • Rotational movement around the circle center of the C-arm ( 6 ) Device according to claim 4, characterized in that the therapy source ( 18 ) by means of a positive and without tools to use quick release on the C-arm ( 6 ) is held. Device according to one of claims 4-5, characterized in that the C-arm ( 6 ) is controlled by the image processing and control computer controlled by electric motor drive the adjustment axes. Device according to one of Claims 4-6, characterized in that the therapy source ( 18 ) is controlled by the image processing and control computer, adjusted by an electric motor. Device according to one of Claims 4-7, characterized in that the image processing and control computer has a computer program for 3D reconstruction from 2D X-ray projection images, and the image processing and control computer, utilizing the kinematics of the X-ray diagnostic device, focuses ( 19 ) of the therapy source ( 18 ) to a selected in the 3D model of an operator point with a selected direction by adjusting the C-arm ( 6 ) positioned in the adjustment axes. Device according to one of Claims 4-8, characterized in that, after the removal of the therapy source ( 18 ) of the C-arm ( 6 ) can be used as a complete mobile X-ray diagnostic device.

Images